What Is Priapism
Priapism refers to the priapism that is not related to sexual desire. Priapism occurs when the priapism lasts for more than 6 hours.
Priapism is classified into several different types
Priapism has traditionally been divided into primary (specific) and secondary.
According to the blood flow situation, the patients were divided into low blood flow type (ischemic) and high blood flow type (non-ischemic). The former due to venous obstruction (venous obstruction) and the latter due to abnormal arterial blood injection (arterial).
Priapism can also be classified as acute, intermittent (recurrent or intermittent, such as sickle cell anemia) and chronic (usually of the high blood flow type). At the early stage of priapism, all patients had a irrational priapism, and later developed into high blood flow type.
What Is The Cause Of Priapism
According to statistics, 30%–40% of priapism is primary, and the etiology of most priapism is unknown.
Secondary causes include:
- Thromboembolic diseases (sickle cell anemia, fat embolism, etc.)
- Neurological diseases (spinal cord injury and lesion, spinal stenosis, etc.)
- Tumors (metastatic cancers such as prostate cancer and kidney cancer, leukemia, melanoma, etc.)
- Trauma (perineum or genital injury, etc.)
- Infection or poisoning (dysentery, rabies, etc.)
- Medications (antidepressants, α -adrenergic blockers, anticoagulants, etc.)
- Injection of parenteral nutrition, such as injection of a vasoactive agent into that corpus cavernosum.
Priapism of low blood flow type is generally impaired by the mechanism of penile erectile decline. Excessive secretion of neurotransmitters and obstruction of venous return lead to long-term relaxation of smooth muscle in the cavernous body. As a result, the pressure in the cavernous body continuously maintains 10.06–15.60 kPa (80–120 mmHg) and gradually deteriorates to an ischemic state.
The frequency of recurrent priapism ranged from several times a day to once a few months. After the first attack of ischemic priapism, the adrenal or endothelial mediated mechanism controlling penile erectile regression changed functionally.
All priapism initially presents as a non-ischemic, high-blood flow type, but in most cases venous embolism, acidosis, and hypoxia occur 6 hours later and finally develop into a typical, low-blood flow type. In some cases, high blood flow volume was continuously maintained, and the cavernous venous return was patent with adequate oxygenation. Because the venous access is open, the erect penis can be compressed, and the hardness of erection ranges from mild to moderate, sexual stimulation can increase the hardness of the penis.
What Symptom Does Priapism Have
In the absence of sexual desire, the penis erects continuously for a long time, accompanied by pain in the penis.
The cavernous body of the penis is congested and firm, while the cavernous body of the urethra and the glans penis are soft.
The common age groups of priapism include 5–10 years old and 20–50 years old. It usually involves only the cavernous body of the penis, and most cases occur at night when the penis is congested.
If priapism of low blood flow type lasts for several hours, it will cause pain due to tissue ischemia, and the priapism will be hard. For the high blood flow type, there is little pain in the penis, and the penis cannot reach full erectile hardness. Most cases of this type usually have a history of perineal or penile trauma, in which the penis is still fully erect after treatment with arterial embolization or surgical ligation, but it usually takes weeks to months.
How To Check For Priapism
The blood gas analysis of cavernous blood can distinguish high blood flow type and low blood flow type. The former blood gas analysis value is the same as the arterial blood, the latter is the same as the venous blood. Notably, priapism in the early stage was of high blood flow type.
Cavernous angiography and color ultrasound Doppler examination
Cavernous angiography: when the vein is blocked, the blood flow stops, and then it belongs to the low blood flow type. The cavernous blood with rapid reflux belongs to the high blood flow type.
Color Doppler ultrasonography: The low blood flow pattern showed minimal arterial blood flow and cavernous expansion. The high blood flow type can show arterial rupture and an abnormal blood pool in the vascular injury area.
How To Prevent Priapism
Maintain an optimistic and open-minded state of mind, good at adjusting and controlling bad emotions.
Abstemious sex avoids intense sexual stimulation.
Eat less fatty and sweet food, less alcohol, eat more coarse grain, radish, green vegetables.
Don't abuse all kinds of supplements to nourish kidney and strengthen yang.
How To Treat Priapism
Priapism can be divided into non-surgical treatment and surgical treatment in two ways.
Low blood flow type priapism
The therapeutic purposes are to increase venous return to resolve the penile swelling, prevent damage caused by persistent ischemia of the cavernous body, and relieve pain. It should be noted that non-surgical medication, in contrast to surgical treatment, prolongs treatment and also increases the chance of cavernous fibrosis and impotency.
Low blood flow type of priapism has a greater probability of causing impotence, but if cured within 12 to 24 hours with drugs, almost all can restore erectile function. Alpha-adrenergic hormone agents are commonly used drugs, as to whether this drug should be used, need to follow the doctor's advice.
Medication may cause complications, including acute hypertension, headache, palpitations, and arrhythmias induced by α -adrenergic therapy.
High blood flow type priapism
Early local ice bag cold compress causes vasoconstriction, and the damaged blood vessels may spontaneously form thrombus. However, most cavernous artery ruptures cannot heal by themselves, and internal pudendal arteriography and embolization are often needed. There have been successful reports of intra-arterial injection of methylene blue and intra-arterial injection of autologous blood clots for embolization treatment in recent years.
The patients with high blood flow volume had better prognosis, and compared with those with low blood flow volume, the incidence of impotence was not high.
For abnormal ischemic penis, the purpose is to dredge blood vessels and restore the normal flow of cavernous blood.
Arterial embolization is generally adopted for the treatment of priapism of high blood flow type. In some cases, when simple arterial embolization is ineffective, ligation of the supply vessel that lacerated the artery is required to be effective.
How To Identify Priapism
Clinical priapism is differentiated from physiological priapism. Under normal circumstances, when normal men are having sex, their penises can erect naturally, but in after ejaculation, their penises tend to soften naturally, which is a physiological erection. Even if some people have strong sexual desire, they can have erectile intercourse again soon in after ejaculation. But from ejaculation to repeated erection, there should be a short softening time, and there is no pain of penis.
Priapism of the penis, regardless of whether there is ejaculation, after sexual intercourse the penis is still not soft, at the same time also can see many pathological changes and characteristics, so the two is not difficult to identify.